Tag Archives: Training

Motivations for Becoming a Therapist

I just finished my first semester in a practicum placement, and I have begun to doubt my decision to become a therapist. I decided to enroll in graduate school because I liked to talk to people and heard from my friends that I was a good listener. Seeing clients this semester was much harder than I expected, and I didn’t feel like I was able to help them very much. How can I dnew2ecide whether to stay in the program or leave to pursue a different career?

The experiences that lead us to enter the field of counseling or psychotherapy are varied but often include ways we have taken a helping role in our personal relationships. The topic of our motivations to become a therapist, covered in Chapter 1 of my book, is complex because it includes emotions outside of our awareness as well as thoughts and feelings that we can identify directly. I’ll discuss some ways you can identify aspects of your motivation that may be influencing your doubts, then recommend how to approach your career decision.

Your enjoyment of conversations with your friends and feedback about your listening skills are common factors in leading someone to consider the psychotherapy field. An initial step in identifying more about your motivation is to reflect on what aspect of these conversations was most enjoyable to you. Did you like the process of getting to know someone more intimately, did you like to follow their stories, were you attracted to analyzing their problems or understanding their feelings? Getting more specific about the experiences that led you to this field will give you more information about your choice to enroll in a graduate program.

Next, it is important to look at aspects of your motivation that are less obvious and may not have entered your conscious awareness. Reflect on what you didn’t do or say in your social interactions or what you avoided by being a good listener. It’s possible that you are uncomfortable with the vulnerability that comes with sharing your own thoughts and feelings. You may have adopted a caretaking role because it was expected and/or rewarded in your family and culture or you may focus on others in order to avoid facing painful memories or being alone with your struggles.

Once you have looked more deeply at your motivation, examine the benefits that have come with your interpersonal style. Being a good listener may enable you to feel effective and empowered, and it may be a source of positive self-esteem as well as praise from others. If you help your friends and family members solve their problems, you can be less worried about your own difficulties. It is natural to assume that you will feel the same rewards with your clients, but clinical work is slower and more complex than personal interactions. It can be discouraging to face the difference between your expectations and the reality of working with clients whose problems involve psychological distress, sociocultural stressors, and mental health conditions. If you decide to stay on your path to becoming a therapist, you will need to adjust your expectations and find rewards in clinical work that are different than in your personal relationships.

Having engaged in self-reflection, I recommend that you reach out to others who can assist you in addressing your career question. Discouragement and doubt is often part of the learning process, and you are likely to feel understood and reassured by talking with professors and fellow students in your academic program and with supervisors and colleagues in your practicum setting. If you’re not already seeing a psychotherapist, this is a good time to begin personal therapy to learn more about the experiences that contributed to your career choice and to explore the meaning of your disappointment as a new therapist.

I hope you found this helpful in understanding more about your motivations for becoming a therapist. If you’re interested in reading more about this and related issues, click here to order from Amazon or here to order from Routledge.

Generational Differences in Therapy

stock-photo-27330798-senior-woman-and-psychiatristI have been working for the past year with a 78-year-old woman who has a moderate level of depression. She has a limited income, lives alone and has very little contact with other people. I have suggested several resources, including some that are online, that she could use to reduce her isolation. She agrees with me in session but doesn’t follow through. I’m starting to feel both frustrated and discouraged about being able to help her. I talked with my supervisor about ending the therapy but she told me to keep trying.

This question highlights the way in which generational differences can enter into therapy. When we work with individuals who are separated by one or two generations from us, we need to be aware of the age-related psychological issues facing our clients as well as the cultural differences that exist between us.

Starting with the psychological issues facing your client, she may be facing a high degree of loss and grief related to each of the risk factors you mention: limited income, living alone and lacking contact with others. Find out whether there were significant changes in your client’s life in the two to five years before she became depressed. If so, she may still be grieving the loss of income and financial status, the death of a spouse or close friends, and/or facing health problems that reduce her mobility. Even if these risk factors were present before she became depressed, she may have become less able to stretch her budget, participate in social activities or function independently as she ages. If you haven’t given her an opportunity to talk about feelings of loss or offered your empathy for her grief, I would suggest doing so. She will need to feel understood emotionally before she is ready to follow your suggestions about other resources that might help to improve her depression.

Another set of psychological issues arises in the fact that your relationship with your client mirrors a parent/child or grandparent/grandchild relationship for both of you. On your side, your frustration and discouragement probably include feelings you have about your parents or grandparents who faced or are facing some of the same issues as your client. Talk with your supervisor and therapist about these personal relationships to gain a better understanding of your countertransference. On your client’s side, working with a therapist who is young enough to be her child or grandchild exacerbates the sense of invisibility and devaluation she may feel as an older person in a culture that equates youth with worth. Your suggestions may feel condescending or invalidating if you are assuming you know more than she does about her experience and needs.

Moving to a cultural perspective, your client’s values and world view are different from yours due to the generational differences between you. Your client was a child during the Great Depression and World War II, came of age during a time of nationwide financial expansion, and experienced the civil rights, anti-Vietnam War and feminist movements as a young adult. Her experience of technology has spanned the period from radio and black-and-white television to internet and smart phones. It is a mistake to assume that she is comfortable, either emotionally or technologically, using online resources to reduce her social isolation. Her agreement with your suggestions may reflect a deferential attitude toward professionals who hold positions of authority, based in the values of her generation. Viewing your relationship as a cross-cultural one may help you to bridge your differences and approach your client with curiosity and interest.

I hope you find these suggestions helpful in working across generational differences in therapy. Please email me with comments, questions or suggestions for future blog topics.

Orientation to a New Training Site

new2I just started at my practicum or field placement site and I feel pretty overwhelmed.  What can I do to reduce my anxiety?

Starting at a new training site can be stressful, whether it’s your first placement or your fourth.  There are several things you can do to feel more confident and grounded.  As you read the suggestions below, you will probably find that some seem more relevant than others, based on your typical response to a new situation.

It is often helpful to review the requirements and procedures for your new site during the first week or two before you see your first client.  Some training agencies have a formal period of orientation and training and others are more informal.  Whatever the practice at your site, you will feel more prepared if you know 1) the treatment frame, i.e., where and when you will see clients, whether and how the client pays for sessions, how long sessions last and whether there is a limit on the number of sessions you will have; 2) the forms to be completed and signed by you and the client in the first session; and 3) agency procedures for clinical emergencies and back-up emergency supervision.  If this information isn’t provided in a formal orientation process, you can ask your supervisor or another more experienced colleague.

A second way to reduce anxiety is to think about ways to connect empathically with your assigned clients or the client population at your training site.  Often you will be working with clients who have survived serious trauma and are living with discrimination, prejudice, and poverty.  Instead of focusing on the client’s history and current circumstances, which can leave you feeling inadequate to make an impact, think about what your client may be feeling in coming to a session with you.  It is likely that she/he brings fear, shame and distrust to your first encounter as well as coping strategies that have enabled her/him to survive painful experiences.  Remember that your desire to understand your client is an essential and powerful first step in your relationship and will instill hope that you may have something helpful to offer.

Another very important aspect of managing the stress of starting in a new training site is to pay attention to your own physical, mental and emotional health.  You may be juggling school, job and family responsibilities in addition to your field placement limiting the time you have to take care of yourself.  In addition, many of us come into the behavioral health field with patterns of caretaking and self-neglect.  Working to balance our own needs with those of our clients is as much a part of the learning process as gaining clinical knowledge and skill.  You can start with something relatively simple like taking a 10-15 minute break to walk, stretch or do a mindfulness exercise during your day or bringing a healthy snack to work.  Supportive personal and professional relationships are also important, and personal psychotherapy is especially useful during clinical training.

I hope some of these suggestions help you in this overwhelming time.  Please email me with comments, questions or suggestions for future blog topics.